POS0781 RESIDUAL DISEASE ACTIVITY IN SLE: A REAL-LIFE CROSS-SECTIONAL STUDY IN THREE TERTIARY CENTRES TO EXPLORE THE ROOM FOR NOVEL THERAPIES
Authors: O. Gioti, M. Nikoloudaki, K. Chavatza, E. Theotikos, A. Elezoglou, P. Sidiropoulos, G. Bertsias, D. Boumpas, A. Fanouriakis
Journal: Annals of the Rheumatic Diseases (2022)

Background According to updated EULAR recommendations, the goal of treatment in systemic lupus erythematosus (SLE) should be remission or low disease activity in all organ systems, achieved with the least possible dose of glucocorticoids. 1 The proportion of patients achieving these two activity states under conventional therapies may vary between different patient cohorts and clinical settings. Objectives To assess the current disease activity state of SLE patients during their most recent visit in three tertiary centres experienced in the management of SLE. Methods In a cross-sectional study, patients were categorized as: 1) Remission off-therapy : SLE Disease Activity Index (SLEDAI)=0 without glucocorticoids (GC) or immunosuppressive drugs (IS), 2) Remission on-therapy: SLEDAI=0, GC ≤5mg/day prednisone (Pz) and/or IS (conventional and biologic, maintenance phase), 3) Low disease activity (LDA ): SLEDAI ≤4, Pz ≤7.5mg/day and/or IS (maintenance phase), 4) Active/Non-optimally controlled: SLEDAI &gt;4 and/or Pz &gt;7.5mg/day and/or IS (induction phase). 2 Hydroxychloroquine (HCQ) was allowed in all groups. Results A total of 332 patients were included [93.1% female, mean (SD) age 48.5 (14.7) years, median (IQR) disease duration 6.5 (12.4) years]. 81% (n=269) of patients were on HCQ and 69.6% (n=231) were receiving an additional IS at last visit. Regarding glucocorticoids (GC), almost half of our patients (48.2%, n=160) were not receiving any GC and of those receiving, only 7.8% (n=26) were receiving a Pz dose &gt; 7.5 mg/day. Mean (SD) total and clinical SLEDAI were 3.7 (3.0) and 3.0 (2.9), respectively. At their most recent visit, 33.7% (n=112) of patients had no clinical activity (clinical SLEDAI=0) and 24.4% (n=81) had neither clinical nor serological activity (total SLEDAI=0). 31.6% and 49.1% of patients had a total SLEDAI-2K ≥6 and a clinical SLEDAI-2K ≥4, respectively (Table 1). Regarding disease activity states, 23.2% (n=77) of patients were in remission (off or on therapy), 36.7% (n=122) were in LDA, while 40.1% (n=133) were categorized as non-optimally controlled. In the latter group, a total SLEDAI &gt; 4 was present in most of patients (79.2% vs. 21.9% for prednisone &gt; 7.5 mg/day and 19.8% for IS at induction regimen). In patients with LDA or non-optimally controlled disease, activity was mainly driven by the mucocutaneous and musculoskeletal components of SLEDAI, along with serologic activity (Figure 1). The latter was more common in LN patients. Overall, 83 patients (25.0%) in our cohort had evidence of serologic activity, of whom 31 (9.3% of total) had a clinical SLEDAI of 0. Table 1. Distribution of patients based on total and clinical SLEDAI-2K score at most recent visit Total SLEDAI Clinical SLEDAI Score Patients, n(%) Score Patients, n(%) 0 81(24.4) 0 112(33.7) 1-5 146(44) 1-3 57(17.2) 6-10 101(30.4) 4-8 154(46.5) &gt;10 4(1.2) &gt;8 9(2.7) Figure 1. Components of SLEDAI-2K at most recent visit (total cohort of patients and patients with LN) Conclusion Although a significant proportion of our patients were on HCQ and additional IS, about 40% of them were not in optimal control. Yet, residual disease activity, based on SLEDAI-2K, was moderate, compared to relatively high mean baseline SLEDAI-2K of lupus trials. These data provide a pragmatic view of lupus patients, who could be potential candidates for novel treatments or inclusion in clinical trials. References: [1]Fanouriakis A, Kostopoulou M, Alunno A, et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann Rheum Dis 2019; 78: 736–745. [2]Ugarte-Gil MF, Wojdyla D, Pons-Estel GJ, et al. Remission and Low Disease Activity Status (LDAS) protect lupus patients from damage occurrence: data from a multiethnic, multinational Latin American Lupus Cohort (GLADEL). Ann Rheum Dis 2017; 76: 2071–2074. Disclosure of Interests None declared